Thickened nails on a child

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A gentleman brought his 16 month old male child in for an assessment yesterday.

Clinical assessment revealed that all the toes were thickened and both 1st were also very involuted, No OC or infections. No infection in the nail according to tests conducted by the GP.

No history of any problems at birth, parents nails are normal along with siblins.

The child is black and does exist a number of birth marks. the big toes did not have nails at the time of birth.

AJ motion was normal, toes alignment and arch shape normal. Walking patterns seemed normal, child walks and plays without any problems.

The child sometimes points at his toes but they do not appear to be causing pain.

Questions.

1. Does any body have similar experience of this problem and is it likely that the nails will become a normal shape or will they continue to thicken as they do in adults.

2. Any further advice that I should give the parents, I have advised on cutting and filing technique.

Kind Regards,

Mathew Vaughan
Feet in Focus

 

Hi Mathew,

This could be pachyonychia congenita - a congenital condition causing faulty protein synthesis.

If this is the correct diagnosis there is nothing that can be done except manage the nails for comfort, function and aesthetic appearance by reduction as often as necessary.

Another condition that gives the nailplate the appearance of thickness is pterygium unguis. Here the pulp occupies the space that should be the hyponychium and the nailplate does not separate at the onychodermal band as it should.

Unfortunate, but at 16 months he's probably got it for life. But there are worse conditions to be born with.

 

Mathew,
About the unusual nails on the child.........you mentioned that the GP did not find any fungal elements. You might recheck that yourself. I have found some GPs either don't get a good sample or send the sample to a lab that only gets a KOH and doesn't try growing the culture out. There is a margin of error for KOH tests, like everything else, but if one just relies on one test, things can be overlooked. Dave Omaha NE